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American Journal of Cardiovascular Drugs

, Volume 19, Issue 2, pp 99–105 | Cite as

Improving Survival in Patients with Pulmonary Arterial Hypertension: Focus on Intravenous Epoprostenol

  • Eftychia DemeroutiEmail author
  • Panagiotis Karyofyllis
  • Athanassios Manginas
  • Anastasia Anthi
  • George Karatasakis
  • George Athanassopoulos
  • Vassilios Voudris
Leading Article
  • 213 Downloads

Abstract

Pulmonary arterial hypertension represents a devastating disease, causing progressive increase of pulmonary vascular resistance leading to right ventricular dysfunction and death. Therapeutic management has rapidly advanced in recent years due to improved understanding of pathophysiology and new drugs have been developed; however, survival remains poor. Oral agents as phosphodiesterase type V inhibitors, the soluble guanylyl cyclase stimulator riociguat, the prostacyclin receptor agonist selexipag and the endothelin receptor antagonists have each achieved evidence-based validation and are recommended for pulmonary arterial hypertension. Initial oral monotherapy or combination therapy is recommended for patients with low or intermediate risk according to each patient’s risk stratification. Intravenous epoprostenol is a synthetic prostacyclin and the first drug approved for the disease. Although it represents the only treatment shown to reduce mortality, it is underused. Survival rates for patients treated with oral combination drug therapies are lower than those for patients treated with initial combination therapies including intravenous epoprostenol. This raises the interesting question of whether intermediate risk pulmonary arterial hypertension patients should be routinely introduced to therapies including intravenous epoprostenol rather than combination oral therapies.

Notes

Compliance with Ethical Standards

Funding

No external funding was used in the preparation of this manuscript.

Conflict of Interest

Eftychia Demerouti has received speaker honorarium and fees as advisory board member from Actelion Pharmaceutical Hellas, MSD Hellas and from Glaxo Smithkline. Panagiotis Karyofyllis has received speaker honorarium and fees as advisory board member from Actelion Pharmaceuticals Hellas and MSD Hellas.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Noninvasive Department of CardiologyOnassis Cardiac Surgery CenterAthensGreece
  2. 2.Interventional Department of CardiologyOnassis Cardiac Surgery CenterAthensGreece
  3. 3.Interventional Cardiology and Cardiology DepartmentMediterraneo HospitalAthensGreece
  4. 4.Intensive Care Unit DepartmentAttikon University HospitalAthensGreece

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